pdf of this article

For more information, contact:


Zoe Stefanadis, RPh

105 Conner Drive, Suite 1200
Wilshire I Building

Chapel Hill, NC 27514

Telephone: (919) 967-8805

Fax: (919) 967-8205

Hormonal Balance: A Key to Women’s Health

“Any consideration of women’s health has to include hormones,” observes pharmacist Zoe Stefanadis, founder and owner of Chapel Hill Compounding. “Hormones are essential for every cell in the body, not just the heart, bone, and brain cells. And hormone imbalances are a particularly challenging problem for women—often escalating during perimenopause or menopause.”

Pharmacist Zoe Stefanadis

“This can have a huge impact on quality of life,” she notes. “When hormone levels are low, organ systems don’t function as well and the whole hormonal balance is thrown off. And, for many women, hormone fluctuations result in mood swings, vaginal dryness, chills and/or night sweats, sleep problems, lack of stamina, hot flashes, and/or weight gain.”

BHRT: Restoring Quality of Life

Regaining hormonal balance—and restoring a healthy quality of life—is the goal of Bioidentical Hormone Replacement Therapy (BHRT), she explains. “The only way to supplement what the body has stopped producing, or is producing less of, is to put back exactly the same natural—bioidentical—hormones, including estrogen, progesterone, DHEA, and testosterone.

“BHRT begins with testing,” explains Ms. Stefanadis. “I suggest saliva or blood-spot testing because this approach reflects the cellular level of hormones, and empowers the patient, as well.

“As a compounder, I can’t stress how important BHRT is, because all it takes is just one little chemical group to be off to change everything. I equate it to a lock and key. The key might have all those ridges and fit into the lock, but if one of those ridges is off, it’s not going to open the door. Our bodies recognize these small changes, and they can make a huge difference in a woman’s health: keeping our bones and cardiovascular system protected, as well as our minds sharp.”

Balancing Hormones: A Complex Task

“The balance of sex hormones definitely has an effect on how thyroid hormones are functioning,” says Ms. Stefanadis. “If a woman has estrogen dominance, it impedes the process of T4, an inactive thyroid hormone, that’s made by the thyroid gland to convert into T3. If you’re in an estrogen dominant state, you may be having symptoms that make you think that it’s your estrogen or progesterone, when in fact, it could be thyroid-related. Furthermore, estrogen dominance can run in families and a woman can be estrogen dominant for the majority of her life and not realize it until those transitions start to happen.”

Conventional thyroid tests, like TSH, don’t always pick up these issues, she points out. “TSH only shows us how much T4 is being produced. There are a whole lot of pathways that have to happen to covert T4 to T3. For that reason, we use a blood-spot test, to give us a better idea of what’s actually on the cellular level. This test confirms whether T4 is getting converted to T3, as well as telling us what’s on the cellular level to see what and how it balances with other hormones.

“I’ve had many patients tell me that their doctors have done the traditional testing and the results have all been normal; but the blood-spot test revealed a problem. Remember that ‘normal’ is a range—and isn’t always right in the middle, it might be on the far right or left of ‘normal.’ So, if a woman is having symptoms, we need to make sure that we address that.”

Among the challenges of achieving hormonal balance, notes Ms. Stefanadis, are what is known as endocrine disruptors. “these are chemical substances that mimic hormones, and when they enter the body, they disrupt the functions of naturally secreted hormones. They include pesticides, chemicals in flame retardants, BPA, even some foods and ingredients that we use for preservatives and antimicrobials. So, when determining the need for various hormones, we have to take into account the role these endocrine disrupters are playing.

“And I always include vitamin D in this conversation. Vitamin D’s chemical structure is just basically a hormone as well. And what we’re seeing today, is that everyone is low in vitamin D. It used to be that you only needed to take 400 units a day, now we’re looking at suggested doses of 5,000 to 10,000 a day just to get those numbers high enough. And vitamin D is so important and not only for bone, but also for a lot of other biological processes that involve hormones.”

BHRT: An Individual Approach

Testing is the first step of a process to restore hormonal balance, explains Ms. Stefanadis. “Testing gives a good snapshot of what’s going on internally, then we sit down for a consultation. We look at their symptoms, get a good history, because a lot of times, what’s happened 30 years ago definitely can still have an impact on how a woman is going to feel during perimenopause.

“As a compounding pharmacy,” she says, “we can offer BHRT preparations that are tailor-made for each individual. And we also customize the delivery of the hormones. We’ve found, for example, that transdermal delivery—medications applied directly through the skin—is a particularly good approach for BHRT because it’s a more natural delivery system, the body recognizing it almost in a glandular sense. With this method, we can combine hormones into creams that are easier to use.

“Additionally, some hormones have significant adverse effects and can even be dangerous if taken orally. Estrogen, for example; studies have shown an increase in risk of clotting or stroke; testosterone, can be very hepatotoxic—or rough on the liver—and is not readily absorbed orally.

“For these hormones, we make a transdermal dose or sometimes a sublingual dose, which goes under the tongue. Another option is a vaginal application. Progesterone is a very safe hormone taken orally. It’s got some limited absorption factors, but we prepare a slow release that improves that absorption.

“We’re very particular in sourcing our hormones, making sure to have a certificate of analysis of purity and micron size. And one of the benefits of the oral progesterone we use is that it’s metabolized, or absorbed, easily. Not only is it safe, but it may cause drowsiness. So, if I’m working with a woman who has difficulty sleeping, we’ll suggest an oral progesterone dose, thus getting two benefits.”

A Collaborative Process

Ms. Stefanadis is a big proponent of what she calls the “triangle—patient, pharmacist, physician—all working together. I can’t provide hormones without a prescription, but I may be the first person that someone reaches out to and tells of their struggles. And then, not only as a pharmacist, but as a public health professional, my job is to start the conversation. I encourage them to speak to their doctor directly. If they don’t have a one, I can recommend several physicians, and then the three of us work together.”

“My first degree was in public health and my passion has always been removing barriers to health care,” states Ms. Stefanadis. “In the past, women have been treated identically to men, but now we know that our symptoms can be completely different from that of men, such as in the case of a heart attack. I want to empower people so that they know that they have choices and ownership of their own health care.”